Preface

Chapter 8 **Management of Atherosclerotic Carotid Artery Stenosis 205**

David J. Padalino and Eric M. Deshaies

**VI** Contents

Atherosclerosis is a multifactorial and dynamic disease which makes the process of preven‐ tion and management complex.

The clinical studies include the thickness of intima-media tunica, evaluation of the stenosis severity and plaque morphology. These points are important for monitoring plaque stabili‐ zation, and for development of therapeutic strategies.

The book consists of 8 chapters describing the cytoarchitecture of carotid plaques from mor‐ phological and physiopathological points of view. It includes clinical applications such as the effect of statin therapy and new updates for the benefit of the patients.

The book is written for all those working in the field of atherosclerosis, cardiovascular dis‐ eases and basic scientists. Moreover, it is important for linking basic scientists to clinicians.

This book will bring out the state of art of carotid stenosis in the basic and clinical ap‐ proaches for better understanding of the mechanisms and useful therapies for these disease. We hope that would be a new "current trend" understanding new aspects regarding this scientific problematic involving not only anatomical, functional but also clinical questions.

> **Dr. Rita Rezzani** Full Professor of Human Anatomy Chair of Anatomy and Physiopathology Section University of Brescia Italy

**Chapter 1**

**Evaluation and Treatment of Carotid Artery Stenosis**

Stroke is the fourth leading causes of death in the United States. Annually, about 795,000 people suffer from a stroke with about 140,000 people, or 1 in 19, dying each year due to stroke related causes. [1] Between 1995-2005 overall stroke death rate fell 30%, even so, annual health care related costs for stroke patients in 2012 were up to 38.6 billion. [1] It is well recognized that cerebrovascular disease, specifically carotid atherosclerosis and subsequent stenosis, is a leading cause of ischemic stroke, which makes up 87% of all strokes. Due to the significant morbidity and mortality incurred by these patients the identification, management, and

Cerebrovascular disease does not appear to affect all races and genders equally. In addition to the usual cardiovascular risk factors of hypertension, diabetes, and smoking; age, gender and race have also been shown to have an additive effect on stroke risk. In a study by Rockman et al. they looked at a little over 3 million patients for evidence of carotid artery stenosis. After controlling for gender and age differences, they found that there was a marked variation in the prevalence of carotid artery stenosis with Native American subjects having the highest prevalence followed by Caucasians. [2] Yet, based on CDC data, African Americans' risk of having a first stroke is nearly twice that of Caucasians. Overall, as would be expected based on the prevalence of carotid disease, American Indians/Alaska Natives are more likely to have a stroke than other groups. [1] Gender differences have also been analyzed. In a large population based study carotid artery stenosis was detected in 3.8% of men and 2.7% of women. [3] The reasons for these differences are thought in part to be due to carotid plaque differences between men and women. Sangiorgi et al. evaluated

> © 2014 Gates and Indes; licensee InTech. This is a paper distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use,

distribution, and reproduction in any medium, provided the original work is properly cited.

Lindsay Gates and Jeffrey Indes

http://dx.doi.org/10.5772/57258

**1. Introduction**

**2. Epidemiology**

Additional information is available at the end of the chapter

treatment of carotid disease is of paramount importance.
